Latest News
The latest news on fibromyalgia syndrome and chronic fatigue syndrome is posted below in support of Fibromyalgia Network's mission to educate patients and the media with ad-free reporting.
Contact: Kristin Thorson, Editor • Phone:
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E-mail: editor@fmnetnews.com • Website: www.fmnetnews.com
- Patients Challenged when Processing Words and Colors - July 31, 2008
- FDA Approves Second Drug to Treat Fibromyalgia - June 27, 2008
- Are You Becoming Cold-Sensitive? - May 30, 2008
- Diagnosing FM Saves Money - March 27, 2008
Fibro Patients Challenged when Processing Words and Colors
Does your slow reading speed embarrass you, or worse yet, is it interfering with your job productivity? Or, perhaps you keep your finger near the pause button of the DVD remote control in case one of the characters in the movie speaks in a foreign language and subtitles appear across your TV screen. While you may already be frustrated with the limited speed at which you can read and fully comprehend information, the situation can be compounded when family or co-workers become annoyed with you. If you told your doctor about your memory and concentration difficulties, a simple screening test may have falsely labeled you as "normal."
Frank Leavitt, Ph.D., and Robert Katz, M.D., of Rush Medical College in Chicago, IL, just published a study showing that the speed of information processing was significantly impaired in 50 percent of the 67 fibromyalgia patients tested.* Putting their findings into perspective, the authors state, "People with fibromyalgia are essentially doing the same job at roughly half the speed."
If you require more time to process the same amount of stimulus information, how does this relate to the symptom of feeling like you are in a brain fog, or what is often referred to as fibro fog? According to Leavitt and Katz, "Time delays in processing information alter the timing of other cognitive operations. For example, delays in processing can affect what you remember, because time governs the decay of information." So the quicker you can process information, the sooner it can be stored in permanent memory and the greater likelihood that the data actually gets stored. Faster processing speeds also translate into improved accuracy of the details being retained. This occurs because of the reduced odds that the information "fades" or becomes "blurred" before it has a chance to be stored in memory.
Yet, you may be wondering: If fibromyalgia patients have a reduced mental processing speed, why wasn’t this identified years ago? A person's processing speed cannot be determined by a single test. One must measure all factors that influence the overall processing speed, which includes mental speed (i.e., how fast the brain processes info), auditory speed, quickness of pattern recognition, pace of visual scanning, speed of decision making, inspection time, and motor (muscle movement) speed. A deficit in one area could have serious ramifications, but may not be picked up unless all of the aspects that contribute to processing speed are measured.
Leavitt and Katz used a battery of ten tests to evaluate all factors that may influence a person's processing speed. This approach is more extensive than previous studies, and it produces a complete picture of every step involved in the speed of processing all types of information. Sixty-seven fibromyalgia patients (recruited consecutively and not based on whether they complained of brain fog) were compared to 51 non-fibromyalgia subjects with memory complaints (e.g., they had a history of seizures, head trauma, stroke, etc.). The results for both groups were also compared to the standardized norms for each test.
In the reading and color naming tasks, fibromyalgia patients scored substantially poorer than the group of controls that complained of cognitive difficulties. The reading test consisted of asking subjects to read the names of colors printed in black ink (e.g., red, blue or green). The color naming test required subjects to state the color of a row of Xs printed in either red, blue or green ink. In general, people have the ability to read words automatically faster than their ability to name colors. All tests were timed.
Despite how annoyed you may be with your fibro fog, there is an upside to this finding. More than 70 percent of fibromyalgia patients scored in the normal range on at least seven of the ten tests. This means that most of the steps involved in processing information is done in a timely manner, and only the brain areas involved in reading and color naming are affected. So the processing speed deficit in fibromyalgia is selective, but the downside is that researchers do not know what is causing the dysfunction.
The findings by Leavitt and Katz are somewhat paradoxical because fibromyalgia patients performed the worst on the tests that were the easiest. "Unlike the other timed tests in the battery, naming words and colors are relatively mindless tasks that are executed with a minimum of personal effort. In tasks that require a greater demand on taxing process capabilities, the speed in fibromyalgia patients is either similar to or better than the control sample."
While this selective glitch in mental processing speed of reading and color naming may be an oddity, this study shows that for half of the fibromyalgia patient population, fibro fog is definitely a reality! If your doctor refers you for cognitive testing, make sure that the Word and Color naming tasks of the Stroop Test are included. Inquire about the tests to be used before you even set up an appointment. Otherwise, your cognitive complaints may go undetected and your doctor will falsely assume that you are just another complainer.
The University of Washington has an interactive Stroop Test available for you to take online.
* Leavitt F, Katz RS. J Clin Rheumatology 14(4):214-218, August 2008.
FDA Approves Second Drug to Treat Fibromyalgia
Posted: June 27, 2008
The U.S. Food and Drug Administration (FDA) approved Cymbalta (duloxetine) on June 16 for treating fibromyalgia. Cymbalta is the first serotonin-norepinephrine reuptake inhibitor (SNRI) that has been proven to reduce pain in fibromyalgia patients. This is the second FDA-approved medication to treat the disease, while the first was Lyrica (pregabalin) in June 2007.
The Fibromyalgia Network has been reporting on the progress of Cymbalta through clinical trials since the spring of 2004.
SNRI drugs, such as Cymbalta, are thought to relieve pain by increasing the availability of serotonin and norepinephrine (NE) in the central nervous system. These two neurotransmitters help filter out pain signals in the spinal cord so that fewer make it up to the brain. When serotonin and NE are released at the nerve endings, SNRIs latch onto these two neurotransmitters and carry them back across the nerve junction so that both can be reused to fight pain. In a way, SNRIs "recycle" the two neurotransmitters that are low in many patients with fibromyalgia.
In the most recent double-blind, randomized, phase III clinical trial of 520 men and women with fibromyalgia, researchers compared Cymbalta at 20 mg, 60 mg, and 120 mg doses taken once daily for six months versus placebo. People taking the two higher doses (but not 20 mg/day) reported pain reduction after the first week. After three and six months, patients taking either 60 or 120 mg daily reported a significant reduction in pain compared to patients taking the placebo. Aside from measures of pain, the two higher doses of Cymbalta also reduced mental fatigue, which might possibly relate to improvements in mental clarity.
Cymbalta was shown to be equally effective in men and women with and without mood disorders. Even people over 65 years of age reaped similar improvements in pain as those in the younger age groups.
Nausea, dry mouth, constipation, and sleepiness were the most common side effects of the medication. The side effects increased at the higher dose. Weight gain or blood pressure elevations may occur in a subgroup of patients taking Cymbalta.
Details on overcoming side effects, monitoring blood pressure and making adjustments for daytime sleepiness were reported in the January 2008 issue of the Fibromyalgia Network Journal. "The key message is to not give up too soon: try different doses and try taking it at different times during the day. Patients usually find the right approach for them," said Lesley Arnold, M.D. of the University of Cincinnati College of Medicine, in Ohio, and lead investigator for the clinical trials on Cymbalta.
Cymbalta has already been FDA-approved to treat diabetic peripheral neuropathic pain (DPNP), major depressive disorder, and generalized anxiety disorder, all in adults older than 18 years of age.
The FDA also added important warnings and precautions to the Cymbalta prescription information including who should not take this medication.
The July 2008 edition of the Fibromyalgia Network Journal outlines the progress of six additional medications that are currently being tested for the treatment of fibromyalgia.
Are You Becoming Cold-Sensitive?
Posted: May 30, 2008
As people get older, they often relocate to places with a warmer climate. In fact, purchasing a retirement home in a sunny location (such as southern Arizona or Florida) to live in during the winter months is fairly common for those who can afford it. This quest for humans to escape cold weather during their retirement years may have a physiological basis according to Robert Yezierski, Ph.D., and his team at the University of Florida, who looked at the sensitivity to heat and cold stimuli as rats age.
Many chronic, painful conditions tend to increase with age, such as rheumatoid arthritis, diabetes, cancer, and fibromyalgia. "Important to understanding these conditions is the question of how advancing age changes the processing and ultimately the perception of pain," comments Yezierski in his study presented at the May 2008 American Pain Society (APS) meeting.
Rats of varying ages were injected in the hind paws with a substance that causes a temporary state of inflamation and discomfort. Next they were evaluated for changes in thermal sensitivity as a function of advancing age using four different age groups: 8 months, 16 months, 24 months and 32 months. In rat time, 8-10 months of age is considered mature, while 37 months is considered "very old." The rats were tested to determine their relative degree of thermal preference and the speed at which they escaped cold and hot environments (50 degrees F and 112 degrees F).
Yezierski found that the older the rat, the greater their preference to heat (i.e., aversion to cold), implying an increased cold sensitivity as animals age. He also found that the speed at which the 32-month old rats escaped from the cold and hot environments was faster than for any of the other age groups. In fact, the 8- and 16-month old rats were not bothered by exposure to the hot/cold climates.
Although this study was done in rats, not humans, it lends support to the common phenomena expressed by retirement-aged people who can no longer stand the cold and also tend to develop an aversion to extremely hot climates.
Diagnosing Fibromyalgia Saves Money
Posted: March 27, 2008
There are two opposing views about the economic impact of diagnosing people with fibromyalgia. One school of thought, often touted by the very people who cling to the notion that fibromyalgia is not real, says that the mere labeling of a person with fibromyalgia leads to "illness behavior" and an increase in health care costs. According to the other school of thought, making the diagnosis should reduce the number of health care visits and associated medical costs. "If the latter hypothesis is confirmed," write the authors of a recent economic study, "providers might then be legitimately concerned not only with the costs of diagnosing fibromyalgia but also with the cost of not diagnosing fibromyalgia."*
The study, conducted in Great Britain, looked at the medical costs per year of patients not diagnosed with fibromyalgia and compared it to their costs per year after they were diagnosed. In a way, patients served as their own control because it looked at each person’s change in medical expenditures before and after the fibromyalgia diagnosis.
Information about the cost of four categories was obtained: 1) diagnostic tests, 2) medications, 3) referrals to specialists, and 4) visits to the general practitioner (similar to the primary care provider in the United States). Between the years 1998 and 2003, 2,260 new diagnoses of fibromyalgia were recorded. The average age of the patients was 49 years, and 81 percent of the cases were women.
Following diagnosis, study results demonstrated substantial reductions in health care costs. In fact, the overall cost savings per patient, per year was $265. Looking at how this breaks down into the various health resource categories, the savings were as follows: $96 on tests, $89 on medications, $62 on referrals to specialists, and $18 on visits to general practitioners. Understandably, the cost savings would be less for doctor visits because fibromyalgia is a chronic condition and patients still need to regularly see a physician for their fibromyalgia-related health care.
While $265 per patient per year may not sound like a lot of savings, keep in mind the high prevalence rate of fibromyalgia (3-5 percent of the general population). In the United States, if just 10 percent of people with fibromyalgia were currently undiagnosed, the added medical burden would be $2 million per year using the cost valued from the Great Britain study. However, medical costs are considered to be much higher in the United States, so the cost burden of not diagnosing people with fibromyalgia would be substantially more.
The January 14th front page article in the New York Times called into question whether the diagnosis of fibromyalgia was real. The report also stated that diagnosing fibromyalgia placed a financial burden on the health care system. Clearly, these statements were merely opinions that were deceptively promoted as fact. This research paper provides the scientific proof that diagnosing people with fibromyalgia not only reduces unnecessary suffering, but it saves on health care costs too.
* Annemans L, et al. Arthritis Rheum 58(3):895-902, 2008.
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